Brief behavioral treatment for insomnia in older adults with late-life treatment-resistant depression and insomnia: a pilot study

  • Marie Anne GebaraEmail author
  • Elizabeth A. DiNapoli
  • Lisa G. Lederer
  • Adam D. Bramoweth
  • Anne Germain
  • John W. Kasckow
  • Jordan F. Karp
Original Article


Brief behavioral treatment for insomnia (BBTI) is an efficacious treatment of insomnia in older adults. Behavioral treatments for insomnia can also improve depression. However, it is unknown if BBTI is feasible or has an effect in patients with insomnia and late-life treatment-resistant depression (LLTRD). The aims of this study were twofold: to test (1) the feasibility (defined by acceptability and retention rates) of BBTI and (2) the therapeutic potency of BBTI on symptoms of insomnia and depression. Eleven older Veterans with LLTRD and insomnia were recruited in a randomized control trial to receive immediate (4 weeks of BBTI followed by 3 weeks of phone call check-ins and a final in-person 8-week assessment) or delayed [3 weeks of treatment as usual (wait-list control) followed by 4 weeks of BBTI and a final in-person 8-week assessment] BBTI. The primary outcome measures included the Patient Health Questionnaire (minus the sleep item) and the Insomnia Severity Index. BBTI was found to be feasible in older Veterans with insomnia and LLTRD; all participants recommended BBTI and retention rates were 90.9%. There was no difference in treatment effect between the immediate BBTI and delayed BBTI groups at week 4. After both groups (immediate and delayed) received BBTI, improvements were seen in both insomnia (d = 1.06) and depression (d = 0.54) scores. BBTI is a feasible treatment for insomnia in older adults with LLTRD. BBTI may be an effective adjunctive treatment for depression. Larger adequately powered trials are required to confirm these preliminary findings.


Behavioral treatment Insomnia Aging Treatment-resistant depression 



The contents of this article do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.


This work was supported by the Veterns Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center Pilot Project Funds (PI: Gebara) at the Veternans Affairs Pittsburgh Healthcare System and T32 MH019986.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Sleep Research 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Mental Illness Research, Education and Clinical CenterVA Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  4. 4.VA Beckley Healthcare SystemBeckleyUSA
  5. 5.Western Psychiatric Institute and ClinicPittsburghUSA

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